Journal of thoracic disease最新文献

{"title":"Inclusion of anti-vascular therapy as a promising option for later-line treatment of malignant pleural mesothelioma: a retrospective study.","authors":"Keda Shao, Di Wu, Qian Wang, Dong Wang, Yue Hao, Bihui Li, Jianhui Huang, Ziyan Yang, Jingxun Wu, Long Huang, Wenfeng Li, Rui Meng, Jian Feng, Jianfei Fu, Huijing Feng, Shengjie Yang, Ling Xu, Xuefei Shi, Miao Li, Yujuan Wang, Chunwei Xu, Zhengbo Song","doi":"10.21037/jtd-2025-566","DOIUrl":"10.21037/jtd-2025-566","url":null,"abstract":"<p><strong>Background: </strong>Malignant pleural mesothelioma (MPM) is a highly aggressive malignancy with a poor prognosis. While pemetrexed-based chemotherapy and dual immunotherapy are established first-line treatments, optimal second- and later-line therapies remain underexplored. This study aims to evaluate later-line treatment options for MPM.</p><p><strong>Methods: </strong>We retrospectively evaluated the outcomes of 85 patients with MPM who had failed in the first-line treatment between 2006 and 2023 in six hospitals. Survival outcomes were analyzed using Kaplan-Meier methodology, with between-group comparisons performed via log-rank testing. The Cox proportional hazards model was employed for both univariate and multivariate analyses to identify prognostic factors. Treatment response was assessed using standard efficacy endpoints: objective response rate (ORR) and disease control rate (DCR).</p><p><strong>Results: </strong>This retrospective analysis evaluated 85 patients with advanced MPM. The cohort demonstrated a median progression-free survival (PFS) of 3.73 months and a median overall survival (OS) of 12.4 months. In the later-line, combining chemotherapy with anti-vascular therapy showed significant efficacy in median PFS than the chemotherapy scheme (4.57 <i>vs.</i> 3.00 months, P=0.004), as well as differences in median OS (13.00 <i>vs.</i> 10.03 months, P=0.04).</p><p><strong>Conclusions: </strong>For patients with MPM requiring later-line treatment, the combination of chemotherapy and anti-vascular therapy may represent a viable therapeutic alternative, demonstrating an acceptable safety profile.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5687-5697"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior surgical tolerance and effectiveness among lung cancer patients who have never versus ever smoked: a retrospective cohort analysis using real-world clinical data.","authors":"Stephanie Tuminello, Andrew J Kaufman, Andrea Wolf, Dong-Seok Lee, Ardeshir Hakami-Kermani, Brian Housman, Daniel G Nicastri, Emanuela Taioli, Raja M Flores","doi":"10.21037/jtd-2025-741","DOIUrl":"10.21037/jtd-2025-741","url":null,"abstract":"<p><strong>Background: </strong>Mounting evidence suggests that lung cancers differ meaningfully between those with and without a smoking history, including clinical and biological differences that may impact treatment efficiency. However, there is a dearth of real-world, patient-level evidence comparing demographic, clinical, tumor and surgical characteristics of lung cancers among those who have never <i>vs.</i> ever smoked, as well as surgical outcomes. This study sought to fill these research gaps.</p><p><strong>Methods: </strong>Information on patient characteristics, including smoking history, and surgical outcomes was extracted from a real-world thoracic surgery database in New York City. Pearson tests and Spearman tests were used for univariate analysis comparing patients with and without a smoking history; outcomes of surgery were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>Among 1,587 surgically treated lung cancer patients, 332 (20.9%) were cases of lung cancer among those who had never smoked (LCNS) <i>vs.</i> 1,255 (79.1%) cases of lung cancer among those who had ever smoked (LCES). LCNS patients were younger, more likely to be female, and Hispanic; these patients also appeared to be healthier in pre-operative assessment and to have a higher likelihood of lobectomy compared to wedge surgical resection. LCNS tumors were more likely to be adenocarcinoma or neuroendocrine, be located in the lower lobe, and carry <i>EGFR</i> mutations (P>0.05 for all univariate comparisons). Post-surgical outcomes appear to be better for LCNS patients; the relative odds of both additional lung surgery [adjusted odds ratio (OR_adj): 0.53; 95% confidence interval (CI): 0.28-0.94] and mortality (OR_adj: 0.57; 95% CI: 0.34-0.93) were lower in LCNS <i>vs.</i> LCES patients, even after adjustment for confounding; odds of post-surgical complications were lower among LCNS patients, but this was not statistically significant.</p><p><strong>Conclusions: </strong>LCNS and LCES surgical patients differ meaningfully in terms of clino-demographic factors. Our results support surgery as a safe and effective treatment option for LCNS.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5492-5498"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of co-ablation <i>vs</i>. microwave ablation in the treatment of subpleural stage I non-small cell lung cancer: a comparative study.","authors":"Yufeng Wang, Runqi Guo, Zhixin Bie, Bin Li, Xiaoguang Li","doi":"10.21037/jtd-2025-296","DOIUrl":"10.21037/jtd-2025-296","url":null,"abstract":"<p><strong>Background: </strong>Ablation is an effective alternative treatment option for early-stage non-small cell lung cancer (NSCLC) patients who are not candidates for surgery or who refuse surgery. Microwave ablation (MWA) and cryoablation (CA) are both minimally invasive treatment techniques widely used in NSCLC patients, and their safety and efficacy have been verified. This study aimed to compare the safety and efficacy of co-ablation (Co-A) and MWA in the treatment of subpleural stage I NSCLC.</p><p><strong>Methods: </strong>From December 2023 to December 2024, a retrospective analysis was conducted on 87 eligible patients (40 males, 47 females; mean age ± standard deviation: 72.03±9.07 years; age range, 31-88 years). Patients were divided into two groups based on the treatment method: a Co-A group and an MWA group. Recurrence-free survival (RFS) rates and complication rates were compared between the two groups.</p><p><strong>Results: </strong>Co-A had a significantly longer mean operative time compared to MWA (28.26±7.56 <i>vs</i>. 6.37±2.01 min, P<0.001). Postoperative analgesic intervention was significantly lower in the Co-A group (30.4% <i>vs</i>. 45.4%, P=0.03). Mean follow-up time was similar between groups (7.04±2.01 <i>vs</i>. 7.27±2.49 months, P=0.69). RFS rates at study end were 95.7% in Co-A and 100.0% in MWA (P=0.26). Common complications-pneumothorax, transient hemoptysis, and pleural effusion-showed no significant differences in incidence between the two groups (P>0.05). However, pneumothorax requiring chest tube drainage was significantly higher in the Co-A group (34.8% <i>vs</i>. 7.8%, P=0.008).</p><p><strong>Conclusions: </strong>Compared with MWA, Co-A demonstrates no significant difference in efficacy or safety for treating patients with subpleural stage I NSCLC, but is associated with reduced perioperative pain and a longer operative duration.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5534-5546"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of the role of <i>ARG1</i> in the fibrotic process of benign airway stenosis using bioinformatics analysis.","authors":"Yilin Chen, Chengfei Xu, Dongchen Shi, Chengcheng Yang, Shulin Tong, Yi Qin, Wusheng Zhang, Xiang Li, Sen Tian, Yuchao Dong, Hui Shi, Chong Bai","doi":"10.21037/jtd-2024-1987","DOIUrl":"10.21037/jtd-2024-1987","url":null,"abstract":"<p><strong>Background: </strong>Benign airway stenosis (BAS) is a disease characterized by the formation of fibrotic tissue leading to airway stenosis with unclear underlying molecular mechanisms. This study aimed to identify the key genes regulating fibrosis in BAS.</p><p><strong>Methods: </strong>In this study, the fibrotic mechanism of BAS was explored through combined transcriptomic and proteomic analysis. We collected tracheal samples from day 7 of a mouse model of BAS, as well as from normal control mice. These samples underwent transcriptomic and proteomic sequencing, followed by integrative analysis to identify key genes associated with the condition. Subsequently, we assessed airway fibrosis in the BAS model mice after treatment with an inhibitor targeting the identified gene.</p><p><strong>Results: </strong>The analysis revealed 4,336 significantly differentially expressed genes (DEGs) at the transcriptomic level and 1,634 differentially expressed proteins (DEPs) at the proteomic level. Through cross-omics integrative analysis, 195 upregulated genes [designated as correlated DEGs and DEPs (cor-DEGs-DEPs)] exhibited significant concordance in expression patterns at both messenger RNA (mRNA) and protein levels, forming differentially co-expressed gene-protein pairs. Utilizing a combined analysis of transcriptomics and proteomics, we identified the <i>ARG1</i> gene as a significant factor in this process. Inhibition of <i>ARG1</i> was shown to alleviate the fibrotic progression associated with BAS.</p><p><strong>Conclusions: </strong><i>ARG1</i> may play a key role in the progression of BAS, which may provide a promising therapeutic strategy for BAS.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5639-5653"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the progressive-free survival of ALK-positive lung cancer: machine learning algorithm based on habitat imaging.","authors":"Fen Wang, Qinmin Hao, Yizhen Jia, Lincen Zhang, Tongfu Yu, Hai Xu, Mei Yuan","doi":"10.21037/jtd-2025-171","DOIUrl":"10.21037/jtd-2025-171","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer associated with the harbor oncogenic driver mutations or fusions, such as anaplastic lymphoma kinase (ALK), could benefit from representative clinical first-line treatment. And patients with ALK-positive (ALK+) show longer median survival than ALK-negative patients. This study aimed to develop a machine-learning model based on habitat analysis derived from computed tomography (CT) lung images to predict disease progression and explore its prognostic value for progression-free survival (PFS) in patients with (ALK+) lung cancer.</p><p><strong>Methods: </strong>A total of 79 patients with ALK-positive lung cancer and advanced TNM stage (III-IV) at The First Affiliated Hospital of Nanjing Medical University between April 2016 and August 2022 were divided into training (n=63) and testing (n=16) cohorts. Radiomics features were extracted from CT images using a habitat-based method with clustering analysis. Subsequently, the performance of eight machine learning algorithms was compared to build a habitat-radiomics (rad_habitat) model, yielding a rad_habitat_score. Using regression, we developed both a clinical model and a combined model that integrated clinical variables with the rad_habitat_score. Subsequently, these models' performance were evaluated. Univariate and multivariate Cox regression analyses were performed on clinical variables and the rad_habitat_score.</p><p><strong>Results: </strong>Three distinct habitats were identified. Among the eight machine learning algorithms, the multilayer perceptron (MLP) model demonstrated superior performance in handling non-linearity, achieving a higher area under the curve (AUC) of 0.836 [95% confidence interval (CI): 0.628-1.000] in the testing cohort. The combined model (AUC =0.836, 95% CI: 0.628-1.000) exhibited a higher AUC than the clinical model but a similar AUC to the rad_habitat model in the testing set. Delong test revealed a significant difference in the AUC values between the clinical model and the combined model and between the clinical model and rad_habitat model in the training cohort (P=0.002 and P=0.007, respectively), while the AUC values of the other models were not statistically different. Cox regression analysis identified the rad_habitat_score as the only independent predictor of PFS (P<0.001) for patients with high-risk ALK+ lung cancer.</p><p><strong>Conclusions: </strong>The habitat-radiomics approach, utilizing three regional habitats, shows promise for accurately and interpretably identifying disease progression in ALK+ lung cancer. The rad_habitat_score, when combined with clinical features, demonstrated improved predictive accuracy for prognostic stratification compared with the clinical model alone.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"6030-6044"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for post-stroke aspiration pneumonia in long-term hospitalized patients: a retrospective study.","authors":"Mengxia Shen, Zheke Fang, Di Sun, Minyan Sun","doi":"10.21037/jtd-2025-1371","DOIUrl":"10.21037/jtd-2025-1371","url":null,"abstract":"<p><strong>Background: </strong>Aspiration pneumonia (AP) is highly common among stroke patients and significantly impacts their prognosis. This study aimed to explore the risk factors for AP in long-term hospitalized stroke patients.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of long-term hospitalized stroke patients at the Tongde Hospital of Zhejiang Province. The patients were divided into two groups based on whether (or not) they developed AP during hospitalization. The clinical features and blood test indicators of the two groups were compared. Binary logistic regression was employed to identify the risk factors for post-stroke AP.</p><p><strong>Results: </strong>A total of 120 sub-acute or chronic stroke patients were included from August 1, 2021 to March 1, 2025, of whom, 64 experienced AP during hospitalization. The binary logistic regression analysis identified independent risk factors for AP, including water swallow test grades 3-5 [odds ratio (OR) =5.105, 95% confidence interval (CI): 1.260-20.676, P=0.02], requirement of a wheelchair (OR =5.133, 95% CI: 1.232-21.387, P=0.03, compared to those able to walk or stand), being bedridden (OR =6.829, 95% CI: 1.472-31.671, P=0.01, compared to those able to walk or stand), albumin ≤35 g/L (OR =3.362, 95% CI: 1.030-10.977, P=0.045), and C-reactive protein (CRP) (OR =1.123, 95% CI: 1.008-1.250, P=0.035). Significant statistical differences in serum albumin levels were observed between the AP and non-AP group at various hospitalization time points, including admission, 1 month, 2 months, and 3 months, all P<0.001.</p><p><strong>Conclusions: </strong>Our research findings identified dysphagia, an inability to walk or stand, low serum albumin level, and a high CRP level as key factors in predicting the occurrence of post-stroke AP. Our prediction model can be used for early life-style clinical interventions or to inform therapeutic decisions for high-risk patients.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"6229-6241"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel prognostic nomogram to predict survival of patients with esophageal squamous cell carcinoma after definitive chemoradiotherapy.","authors":"Guanhua Chen, Di Liu, Xiaoke Di, Shu Zhou, Yumeng Zhang, Xiaolin Ge","doi":"10.21037/jtd-2024-2051","DOIUrl":"10.21037/jtd-2024-2051","url":null,"abstract":"<p><strong>Background: </strong>Against the backdrop of esophageal cancer's high global incidence, the dominant role of esophageal squamous cell carcinoma (ESCC) with poor prognosis, limited surgical opportunities, and the American Joint Committee on Cancer (AJCC) staging system's insufficiency, there is an urgent need to develop a prognostic nomogram for ESCC patients undergoing chemoradiotherapy. The purpose of this study was to establish a clinical nomogram for effectively predicting overall survival (OS) for patients with non-operated ESCC after definitive chemoradiotherapy.</p><p><strong>Methods: </strong>A total of 869 patients diagnosed with ESCC from 2010 to 2015 were retrieved from the Surveillance, Epidemiology, and End Results database. The nomogram was developed based on independent predictors determined by multivariate Cox regression analyses. Additional external validation was conducted on 318 ESCC patients enrolled from The First Affiliated Hospital of Nanjing Medical University. The receiver operating characteristic curve analysis and calibration plot were utilized to assess the predictive discriminative ability and reliability of the nomogram in both the training cohort and external validation cohort. The clinical practicability was evaluated by decision curve analysis and further comparing the novel model and the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.</p><p><strong>Results: </strong>The multivariate analysis of the training cohort suggested that age, sex, tumor site, tumor size, clinical T stage, clinical N stage were significantly associated with OS and were all incorporated into the nomogram. The results suggested that the novel nomogram performed well with good discrimination and agreement and exhibited more optimal clinical benefits than AJCC 8th staging system. Meanwhile, an online web-server based on the new nomogram was developed for convenient clinical practice.</p><p><strong>Conclusions: </strong>The prognostic nomogram developed in this study demonstrates favorable predictive performance for survival outcomes in ESCC patients receiving definitive chemoradiotherapy. Its discriminative ability, consistency, and clinical benefits surpass those of the AJCC 8th Edition staging system. Additionally, a convenient online tool for the nomogram has been developed. This model can objectively quantify patients' survival risks, providing critical reference for the formulation of individualized treatment strategies and possessing clinical application value.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"6017-6029"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cone beam computed tomography for navigational bronchoscopy.","authors":"Aniek R C Bruinen, Roel L J Verhoeven, Erik H F M van der Heijden","doi":"10.21037/jtd-24-1828","DOIUrl":"10.21037/jtd-24-1828","url":null,"abstract":"<p><p>Cone beam computed tomography (CBCT) is a revolutionary technology that is increasingly being used in interventional pulmonology for the diagnosis and treatment of pulmonary lesions, specifically small peripheral pulmonary lesions (PPLs). CBCT systems can provide detailed three-dimensional (3D) imaging, allowing for 3D lesion as well as instrument positioning information. Currently, only the fixed CBCT systems have been studied as a tool to not only provide 3D scanning information but also allow overlaying information on live fluoroscopy by a feature called augmented fluoroscopy. Using this combination of scanning and augmentation, CBCT can be used as a modality that provides both imaging and guidance in navigation to target lesions in navigation bronchoscopy. Studies have shown that the addition of CBCT to navigation bronchoscopy using other primary navigation guidance techniques can further increase the diagnostic yield of these technologies. The combination of CBCT with robotic assisted bronchoscopy (RAB) is one of the most promising combinations, allowing pulmonologists to navigate complex airways with distal tip control along with detailed 3D positioning information to obtain biopsies and correct for computed tomography (CT)-to-body divergence. It is important for physicians to be properly trained in the use of CBCT, in order to obtain a high diagnostic yield with a low complication rate and to limit radiation exposure to the patient and employees. While further research is needed to fully examine its potential and address challenges, CBCT will likely become the standard of care technology for a wide range of diagnostic and therapeutic procedures in interventional pulmonology. More research needs to be done on the added value and need of CBCT in combination with advanced procedural guidance techniques such as RAB.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"6254-6264"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wait times between lung cancer diagnosis and surgery: national trends, disparities, and impact on long-term survival.","authors":"Claire Perez, Andrew R Brownlee, Lucas Weiser, Justin J J Watson, Kellie Knabe, Charles Fuller, Shruthi Nammalwar, Qiudong Chen, Raffaele Rocco, Harmik J Soukiasian","doi":"10.21037/jtd-2024-2002","DOIUrl":"10.21037/jtd-2024-2002","url":null,"abstract":"<p><strong>Background: </strong>The survival difference associated with delays between lung cancer diagnosis and definitive surgery is poorly defined in contemporary practice. The aim of this study was to evaluate the prevalence of treatment delays, trends in wait times, and survival impact in a national cohort.</p><p><strong>Methods: </strong>All patients with stage I or II non-small cell lung cancer (NSCLC) undergoing anatomic resection in the U.S. from 2004 to 2018 were identified in the National Cancer Database (NCDB). The association between survival and the interval between diagnosis and surgery was evaluated. Cox regression, logistic regression, and propensity score matching were used to adjust for differences in patient characteristics.</p><p><strong>Results: </strong>Between 2004-2018, 1,898,210 patients were diagnosed with lung cancer and 219,723 met the inclusion criteria. The median time between diagnosis and surgery was 30.5 [interquartile range (IQR), 5-50] days. The median wait time increased from 25 (IQR, 0-47) days in 2004 to 38 (IQR, 17-59) days in 2018 (P<0.001). After 1:1 propensity matching, the group contained 83,839 patients with one group waiting >4 and the other ≤4 weeks for surgery. The median age was 68 years and 45.7% [76,647] were men (P<0.6). Overall survival in the propensity matched group was significantly worse in patients waiting >4 weeks for definitive surgery compared with those waiting ≤4 weeks for stage I and II patients (P<0.001). Additionally, significant racial disparities in the interval between diagnosis and surgery were observed. The median wait time for non-Hispanic White patients was 31.0 (IQR, 8-52) days. Non-Hispanic Black patients waited 37.0 (IQR, 9-62) days, adjusted odds ratio (aOR) 1.2 [95% confidence interval (CI): 1.23-1.32, P<0.001] and Hispanic/Latino patients waited 32.0 (IQR, 2-55) days, aOR 0.95 (95% CI: 0.90-1.01, P<0.08).</p><p><strong>Conclusions: </strong>Wait times exceeding 4 weeks between lung cancer diagnosis and surgery for stage I and II NSCLC are increasingly common, particularly among non-Hispanic Black patients, and are associated with worse long-term survival. Reducing time between cancer diagnosis and surgery may represent a therapeutic target to mitigate healthcare disparities.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"5983-5992"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circular RNA circFTO promotes pressure overload-induced cardiac hypertrophy by encoding a novel protein FTO-36aa.","authors":"Rong-Rong Zhu, Qi-Rong Xu, Zhong-Yong Liu, Xue-Liang Zhou","doi":"10.21037/jtd-2025-1462","DOIUrl":"10.21037/jtd-2025-1462","url":null,"abstract":"<p><strong>Background: </strong>Pathological cardiac hypertrophy leading to ventricular remodeling poses a significant threat to human health. Circular RNAs (circRNAs) play a potential role in the dysregulation of cardiac hypertrophy, and recent evidence highlights their translational ability in various diseases. However, it is not clear whether circRNAs play a protein-coding role in myocardial hypertrophy and ventricular remodeling. This study aimed to investigate the role of circRNA derived from the fat mass and obesity-associated (<i>FTO</i>) gene (circFTO), a translatable circRNA, and the circFTO-encoded a 36 amino acid protein (FTO-36aa) in the pathogenesis of myocardial hypertrophy.</p><p><strong>Methods: </strong>A transverse aortic constriction (TAC)-induced hypertrophy mouse model was established. The heart function of the C57BL/6 mice was evaluated. Myocardial structure injury and fibrosis were analyzed by hematoxylin and eosin (H&E) staining and Masson staining. CircRNA microarray assays were used to screen the dysregulated circRNAs. The recombinant adenovirus-associated virus (AAV) was constructed to overexpress or knockdown FTO protein or circFTO. Mass spectrometry analyses, dual-luciferase reporter assays, and polysome profiling analyses were performed to detect the FTO-36aa.</p><p><strong>Results: </strong>The study identified dysregulated circRNAs in sham and TAC models, and found that an upregulated circRNA, circFTO, is generated from the back-splicing of FTO exon 5 and exon 7. The silencing of circFTO by AAV significantly weakened the TAC-induced hypertrophy phenotype. The study also identified a novel protein, FTO-36aa, coded by circFTO, that caused the pro-hypertrophy effect of circFTO. FTO-36aa promoted the ubiquitination-mediated protein degradation of FTO, which suppressed the demethylation of RNA, elevating the global N6-methyladenosine (m⁶A) methylation. Further, the m⁶A reader, IGF2BP2, recognized the circFTO/FTO-36aa elevated m⁶A methylation and increased the messenger RNA (mRNA) stabilities of the m⁶A methylated hypertrophic genes.</p><p><strong>Conclusions: </strong>Overall, this study shed light on the functional importance of alternative splicing-generated circFTO and its coded FTO-36aa during myocardial hypertrophy. The findings provide fundamental insights into the mechanisms of m⁶A methylation regulation in hypertrophic cardiomyocytes.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 8","pages":"6127-6150"},"PeriodicalIF":1.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}